Post-Metabolic Bariatric Surgery Cirrhosis and the Role of Liver Transplantation: A Report from a Referral Transplant Center.

Background: Despite their benefits, metabolic bariatric surgery (MBS) has been associated with rare but severe complications, including liver failure (LF) and the need for orthotopic liver transplantation (OLT). The exact mechanisms underlying MBS-related cirrhosis remain unclear, and comprehensive data on this topic are scarce.

Method: This retrospective study analyzed 10 patients who underwent OLT after MBS due to decompensated LF. Demographic, clinical, and laboratory data were collected and analyzed, including pre- and post-MBS body mass indexes (BMI), liver function tests, and MELD scores.

Results: Mean age was 42.9 years with the female percentage of 40%. Except for two patients who had 110 and 120 months between the MBS and OLT, remaining eight cases had a mean 19.6 months interval between the MBS and OLT. Roux-en-Y gastric bypass (RYGB) being the most common procedures, two of them reported consumption of alcohol, one died afterwards. Four patients died due to different reasons through the study (Two sleeve (SG), and one for each RYGB and one-anastomosis gastric bypass). There were significant correlations between overall survival (OS) and age (Spearman's rank correlation coefficient (r) = 0.85, p = 0.002), bilirubin (r = - 0.74, p = 0.013), and MELD score (r = - 0.69, p = 0.026). Survival with log rank test was only significant for MBS types (p = 0.035). COX regression was significant when compare RYGB vs. SG (Exp(B) = 0.069, p = 0.048).

Conclusion: MBS-related cirrhosis is rare but potentially life-threatening and OLT is the final step with a noticeable risk of mortality. Comprehensive preoperative liver assessment, careful selection of MBS procedures, and close postoperative monitoring are crucial for mitigating risks.